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BACKGROUND: Collaboration strategies refer to policies and practices used to align operations and services across organizations or systems. These strategies can influence implementation of cross-system interventions focused on improving integration of care, but remain under-specified and under-examined. This study identifies collaboration strategies and the conditions under which they affected implementation of Sobriety Treatment and Recovery Teams (START), an evidence-based intervention focused on integrating child welfare and behavioral health services for families involved with both systems. METHODS: Our study sample included 17 county child welfare agencies that implemented START. Data on collaboration strategies and organizational context were obtained from key informant interviews, frontline worker surveys, and contracts. Contextual data were drawn from secondary data, and fidelity data were drawn from an administrative database. Qualitative and quantitative data were integrated using coincidence analysis, and used to identify combinations of conditions that uniquely differentiated agencies with higher and lower fidelity to START. RESULTS: Fidelity was lower for intervention components requiring cross-system collaboration. Although key informants acknowledged the importance of collaboration for START implementation, few agencies used formal collaboration strategies other than staff co-location or reported high communication quality between frontline staff in child welfare and behavioral health. In coincidence analysis, four conditions differentiated agencies with higher and lower fidelity with 100% consistency and 88% coverage. We found that either strong leadership support or, in high need communities, third-party resource support from local behavioral health boards were sufficient for high fidelity. Similarly, in high need communities, absence of third-party resource support was sufficient for low fidelity, while in low need communities, absence of communication quality was sufficient for low fidelity. CONCLUSION: Administrators, frontline workers, and interested third parties (i.e., other stakeholders not directly involved in implementation) can use collaboration strategies to facilitate implementation. However, the effectiveness of collaboration strategies depends on local context. In agencies where internal leadership support for implementation is low but need for intervention is high, third-party resource support may still be sufficient for high fidelity. Further research is needed to test effectiveness of collaboration strategies in different conditions and on a broader range of process and implementation outcomes. TRIALS REGISTRATION: ClinicalTrials.gov, NCT03931005, Registered 04/29/2019, https://classic. CLINICALTRIALS: gov/ct2/show/NCT03931005 .

Purpose: This scoping review aimed to identify behaviour change strategies influencing rehabilitation adherence in adults with tendinopathy, a common musculoskeletal condition requiring prolonged rehabilitation with poor adherence and variable outcomes. Methods: Following the Joanna Briggs Institute (JBI) methodology, seven databases were searched until April 2023. Records included reviews, intervention, and qualitative studies published in English. Behaviour change strategies were deductively coded and mapped to the capability, opportunity, and motivation model of behaviour (COM-B). Results: Eighty-six articles were retained. The primary behaviour change strategies in tendinopathy rehabilitation reports addressed Psychological Capability; from knowledge through education, instruction, and self-monitoring using exercise diaries. Also, Social Opportunity involves demonstration and monitoring of rehabilitation behaviour, and Physical Opportunity focuses on time-efficient programs with access to equipment and health professionals. Few reports addressed Automatic Motivation (positive reinforcement and habit formation). Barriers identified in the reports were Reflective Motivation (negative beliefs and fears), Physical Opportunity (time-constraints), and Physical Capability (pain and comorbidities). Conclusions: Further research should explore the impact of education on beliefs, fears, and pain-management, as well as the effectiveness of teaching habit formation for improved time-management. Implementing these behaviour change strategies may enhance tendinopathy rehabilitation adherence, improving clinical trial efficacy, guiding clinical practice, and impacting patient outcomes. Implications for rehabilitation: Education, instruction and use of an exercise diary (Psychological Capability), demonstration and monitoring of rehabilitation behaviour (Social Opportunity), and a time-efficient program with access to equipment and a health professional (Physical Opportunity) are common behaviour change strategies to improve rehabilitation adherence. A barrier to adherence we identified was negative beliefs about capabilities and consequences, and fear of pain and causing further damage (Reflective Motivation), which may be addressed by appropriate education. Positive reinforcement and teaching habit formation (Automatic Motivation) is not present in reports and should be considered in the future. Physical Capability of tendinopathy patients to perform the rehabilitation program should not be assumed by rehabilitation professionals when prescribing and delivering rehabilitation. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is associated with severe maternal coronavirus disease (COVID-19) and preterm birth and may increase the risk for other complications of [...]

Literature from various academic disciplines indicates that in recent decades, community resilience (CR) has evolved significantly in conceptualization and operationalization. However, the relevance and empirical inclusion of CR in social and health sciences research remain sparse and fragmented. This scoping review, therefore, aimed to assess the conceptualization of CR in social and health sciences research; determine the availability of tools measuring this construct; and identify the psychometric properties of available instruments. Findings highlight how CR has shifted from a peripheral ecological concept to a central goal in the psychosociological discourse. Though several common core elements were identified in the included literature, results indicated little consensus regarding the conceptual or operational definitions of CR. Furthermore, there is minimal evidence on robust metrics that comprehensively measure CR as a complex psychosocial construct. Review results thus highlight the importance, and provide pragmatic implications, regarding the inclusion of core elements of CR in community-based strategies and development efforts. [ABSTRACT FROM AUTHOR]

The macroscopic appearance of a tumor such as hepatocellular carcinoma (HCC) may be defined as its phenotype which is de facto dictated by its genotype. Therefore, macroscopic characteristics of HCC are unlikely random but rather reflect genomic traits of cancer, presumably acting as a valuable source of information that can be retrieved and exploited to infer prognosis. This review aims to provide a comprehensive overview of the available data on the prognostic value of macroscopic characterization in HCC. A total of 57 studies meeting eligible criteria were identified, including patients undergoing liver resection (LR; 47 studies, 83%) or liver transplant (LT; 9 studies, 16%). The following macroscopic variables were investigated: tumor size (n = 42 studies), number of nodules (n = 28), vascular invasion (n = 24), bile duct invasion (n = 6), growth pattern (n = 15), resection margin (n = 11), tumor location (n = 6), capsule (n = 2) and satellite (n = 1). Although the selected studies provided insightful data with notable prognostic performances, a lack of standardization and substantial gaps were noted in the report and the analysis of gross findings. This topic remains incompletely covered. While the available studies underscored the value of macroscopic variables in HCC prognostication, important lacks were also observed. Macroscopic characterization of HCC is likely an underexploited source of prognostic factors that must be actively explored by future multidisciplinary research. [ABSTRACT FROM AUTHOR]

Background: Timely restoration of cerebral blood flow using reperfusion therapy is the most effective maneuver for salvaging penumbra. We re-evaluated the previously described PROTECT (PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy) Plus technique at a tertiary comprehensive stroke center. Methods: We retrospectively analyzed all patients who underwent mechanical thrombectomy with stentrievers between May 2011 and April 2020. Patients were divided between those who underwent PROTECT Plus and those who did not (proximal balloon occlusion with stent retriever only). We compared the groups in terms of reperfusion, groin to reperfusion time, symptomatic intracranial hemorrhage (sICH), modified Rankin Scale (mRS) score at discharge. Results: Within the study period, 167 (71.4%) PROTECT Plus and 67 (28.6%) non-PROTECT patients which met our inclusion criteria. There was no statistically significant difference in the number of patients with successful reperfusion (mTICI >2b) between the techniques (85.0% vs 82.1%; p = 0.58). The PROTECT Plus group had lower rates of mRS ≤2 at discharge (40.1% vs 57.6%; p = 0.016). The rate of sICH was comparable (p = 0.35) between the PROTECT Plus group (7.2%) and the non-PROTECT group (3.0%). Conclusion: The PROTECT Plus technique using a BGC, a distal reperfusion catheter and stent retriever is feasible for recanalization of large vessel occlusions. Successful recanalization, first-pass recanalization and complication rates are similar between PROTECT Plus and non-PROTECT stent retriever techniques. This study adds to an existing body of literature detailing techniques that use both a stent retriever and a distal reperfusion catheter to maximize recanalization for patients with large vessel occlusions. [ABSTRACT FROM AUTHOR]

By 2014, the majority of U.S. states had implemented differential response (DR), a system policy that seeks to serve families of low-to moderate-risk for child maltreatment through family engagement, diversion from formal child protective services investigations, and service provision. However, the effects of DR programs on child welfare dynamics have yet to be evaluated nationally using causal methods. Using a quasi-experimental study design with data drawn from the National Child Abuse and Neglect Data System from 2004 to 2017, we found states with DR programs had approximately 19% fewer substantiated reports, 25% fewer children substantiated for neglect, and a 17% reduction in foster care services utilization when compared to states without DR programs. We find these estimates to be robust to the opioid epidemic and incarceration rates. Additional research is needed to better characterize DR programs and isolate the effects of DR programs geographically. [ABSTRACT FROM AUTHOR]

Although student mobility and educational border crossings, particularly from non‐Western economies to English‐speaking countries, such as the United States, are not new, theoretical concepts that help illuminate global student mobilities rarely examine lived realities of university students in transnational spaces. We aim to explore the phenomenon of 'spiritual homelessness' experienced by international students in the United States and how their perceived sense of belonging and not belonging in their home or host places contribute to their reconstruction of identity in transnational spaces. Based on a 3‐hour focus group discussion with international students from eight different countries (N = 11) studying at a large southern university in the United States, this study highlights the nexus between multiple, contradictory and simultaneous processes of belonging and identity through student‐defined transnational higher education spaces. Findings demonstrate that international students are part of multiple and contradictory discourses, where there is a synergetic construction of transnational spaces as open and diverse, but also discriminatory and exclusionary as they negotiate where they belong or not belong. This study provides a critical scoping of student‐defined spaces and foregrounds the typological theoretical construct of spiritual homelessness to provide new insights into global student mobilities and identity reconstruction in transnational spaces. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Antipsychotic medications (AP) are inappropriately prescribed to young people. The goal of this pragmatic trial was to test a four‐component approach to improved targeting of antipsychotic prescribing to people aged ≥3 and <18 years.Clinicians in four health systems were cluster randomized by the number of previous AP orders and service line – specialty mental health and all others. Intervention arm clinicians received a best practice alert and child psychiatrist consultation and feedback. Families received system navigation and expedited access to psychotherapy. Primary outcomes were total days' supply of AP medication and proportion of youth with any AP supply at 6 months. We estimated the log‐odds of AP use at 6 months and the relative rate of AP over 6 months. The Safer and Targeted Use of Antipsychotics in Youth (SUAY) trial took place between 3/2018 and 12/2020.The trial enrolled 733 patients. The odds ratio (OR) comparing use at 6 months was 0.75 (95% CI: 0.52, 1.09). The mean number of days using AP was 118.5 for intervention patients and 128.2 for control patients (relative risk [RR] = 0.92; 95% CI: 0.81–1.04). Exploratory heterogeneity of treatment effects (HTE) was not detected in groups defined by age, gender, provider specialty, and insurance type. HTE by race/ethnicity was present: among youth of color, mean days' supply was 103.2 for intervention arm and 131.2 for the control arm (RR 0.79, 95% CI: 0.67–0.93). Among secondary outcomes, only new psychotherapy referrals differed with 44.3% (n = 154) of intervention participants having a new order for psychotherapy compared to 33.5% (n = 129) in the control arm (OR 1.47: 95% CI: 1.01–2.14).This intervention did not result in less AP use at 6 months or a reduction in the days' supply of AP medication, although psychotherapy orders increased. The intervention may be effective for some subgroups. [ABSTRACT FROM AUTHOR]